Retroactive Adjustment Implementation

The Department of Health notified providers on November 3, 2011 that due to the delay in implementation of the required 2% Across the Board reduction to most Medicaid payments, a reconciliation of paid claims would be done in order to determine provider liability for the retroactive period from April 1, 2011 effective date to the implementation date on November 3, 2011.

Based on this reconciliation of paid claims the recoupment of each provider's 2% Across the Board liability will be recovered on a weekly basis commencing in Cycle 1787 (check date 11/21/2011, release date 12/7/2011). The reconciliation consisted of reviewing paid claims from the previous 31 cycles (back to 4/1/2011) and applying the 2% reduction to all non-exempt claims. The total reduction amount for each provider was then divided by 15 (the number of weeks remaining in State fiscal year 2011-12) to establish a weekly recoupment amount. For low volume providers, a minimum weekly recoupment amount of $15.00 was established.

The weekly recoupment amount will appear on paper remittances under financial reason code ATB - Across the Board Reduction, while the 835 electronic remittances will carry the weekly reduction in the PLB segment with qualifier *WU.

All questions should be submitted to the 2% Across the Board electronic mailbox: Please place the topic of your concern in the subject line of your email so that questions may be reviewed by program area. Keep in mind that we will not be able to respond to individual emails; however, responses to frequently asked questions will be posted to the Department's website. Please access the website regularly for the most updated information.

* revision December 2011 PLB qualifier from J1 to WU